10995 SW GARDEN PARK PLACE `*4�
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CITY OF TIGARD ELECTRICALPERPI:T
PERMIT#: ELC2004-00224
DEVELOPMENT SERVICES DATE ISSUED: 5/3/2004
13125 SW Hall Blvd.,Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S103DD-06000
SITE ADDRESS: 109"35 SW GARDEN PERK PL
SUBDIViSIGN: GAARDE PARK ZONING: R-7
BLOCK: LOT : 043 :URISDICTION: TIG
Project Description: Repla(.o meter base.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS_ MISCELLANEOUS_
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 • 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PAN:L:
MANF HM/SVC/FDR• 601+amps - 1000 volts: MINOR LABEL ;101.
SERVICE/FEEDER BRANCH CIRCUITS ADD L INSPECTIONS
0 200 amp: 1 1,N/SERVICE OR FEEDER: PER INSPECTION:
201 •• 400 amp: 1st W/O SRVC OR F)R: PER HOUR:
401 • 600 amp: EA ADD'l. BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ _ _ _ _ PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS >600 VOLT NOMINAL: V —�
Reconnect only: S.C/FDR>= 225 AMPS: CLASS AREPJSPEC OCC:
Owner: Contractor:
JOHNSON,BENTON I/HELEN M HEAR ELECTRIC
10995A SW GARDEN PARK PLACE P O BOX 389
TIGARD,OR 97223 DONALD.OR 9702.0
Phr1ie: Phone: 503-678-1355
Reg#: LIC 20919
-- Ia.E 24-107C
FEES _ Sur, 162-S
Description Date Amount
Required Inspections
I FLrRM i I F.L('Permit t gni•1 $80.30
I'AXI f{"6 Slatc Surcharge 5/+!2004 $6.42 Elect'/ServicE.
Elect'/Final
Total $85,72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,Slate of OR Spe6alty Codes and all other applicable laws
All work will be done in accordance with approved pians This permit will expire if work is not started within 180 days of issuance, or d work is
suspe tfirme►e than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
ru are set forth in OAR 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questidns to OUNC at(503)
2 ••6699 or t•800-332-23 _
Is ued By: r Permit SiE,nature: ^ C lir
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, wase, or rent.
OWNER'S SIGNATURE: DATE;—
-
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC,IN DATE:
LICENSE NO: —
Call 639-4175 by 7:00pm for an Inspection the next bualness day
OFFICE 113�E ONLY
Electrical Permit application ,i11e .�l S' o Electn�al
Dare 11
- iiII1111/9L Permit NO.: &1140Plantun
City of�Tlr;af-d J�, Date,13V. pproval Sign -
� Permit No.:
13125 SW lIa11 I3I%d. p�4 Plan ReviewOther r
Tigard,Oregon 97223 Aja{ Date/By- Permit No.: _
Phone: 503-639-4171 Fax: 50�-598-1,96`01 Post-Review Land Ube
internet: www.ci.tigard.or.us 11\f O G+�� '` Contact
Case No.
��^" Contact J See Page 2 for
24-hoar Inspection Request: 5 9,�W4 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW(Pic se check all that apply)
New construction M DemolitionService river 225 amps- U Health-care facility
commercial E]Hazardous location
�j Addltion/alteration/replacement Other. ❑Service over 320 amps-ratinJ of ❑Building over 10,000 square feet,
CATEGORY OF CONST RUCTION I &2 family dwellings four or more residential units in
�]1 & 2-Family dwelling Commercial/Industrial ❑System over 600 volts nominal one structure
r ACC2SS0 Building- Multi-Family ❑Building over three stores ❑Feeders,400 amps or more
t��_ � ❑Occupant load over 99 f ersons ❑Manufactured structures or RV park
Master Builder ❑Other: ❑Egressnighting plan ❑Other:
JOB SITE INFORMATION and LOCATION Submit_sets of pins with any of the abosc.
The above are not applicable to temporary construction service.
Job site address: /0 "$ ct FEE*SCHEDULE
Suite#: A t.#: Number of ins ections per permit allowed
Project Name: Description Qty Fee(ea.) Total
CS t0 Slte: New residential-single or multi-farnlly per
Cross st7eet/Dir til
qn dwelling unit.Includes attauued garage
Jc 4 ���r>✓N�(,r e i)T G ✓�l st Service Inchrded:
1000 sq.ft.or less 145.15 4
Each additional 500 sq.ft.or portion thereof 33.40 1
SUbdlV1S10n: —� LOt#:
Limited energy,residential 75,00 2
Limited encrily,non residential 75.00 2
Tax map/parcel#: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
3enlces or feeders-Installation,
e° alteration or relocation:
200 amps or less 80.30 brCr,j 2
201 amps to 400 am s 106.85 2
401 amps to 600 amps 160.60 2
PROPERTY OWNERi601 ams to 1000 ams — _ 240.60 2
-- Over 1000 amps or volts _ _ 454.65 2
Name: Reconnect only 6695 2
Address: —�» Temporary services or feeders-installation,
--- alteration,or relocation:
City/State/Zip: _ 200 amps o: less 66.85 1
Phone: — 201 amps to 400 ams 100.30 2
401 to 600 ams 133.75 2
APPLICANT CONTACT PERSON ! Branch circuits-new,alteration,or
Name: extension per panel:
A.Fee for branch circuits with purchase of
Address: _ service or feeder fee,each branch circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase of
service or feeder fee first branch circuit 46.85 2
Phone: FaX:^ Each additional branch circuit b.65 2
E-mail: Misc('_'ervicc or feeder not included):
CONTRACTOR Each pump•jr irrigation circle 5340 2
-- --- Each sign or outline lighting 53.40 2
Job NO: Signal circuit(s)or a limned energy panel,
Business Name: �°. alteration,or extension Pae 2 2
Description:
Address: /0 S G 1 110 P /«ef VA
City/State/?iEach additional Ins ection over the allowable In any of the above:
_ / �7.4,4 Per inspection per hour(min I hour) 1 1 61.50
Phone:S-u3 &1 jr Fax. Sr 3 - E 7 f- - //Gr Fr Investigation fee: _
CCB Lic. #: 'R U y/ Lic. #: �O fit: — Other: _
_ ,,,' :lectrlcal Permit Fees' _
Supervising electrician Subtotal S
si ature required: c-rl let-4-L Pian Revie v(25%of Permit Fee)_ S
Print Name: / Lic. #: f0,2$ State Surch:r e 8%of Permit Fee 3 6 _
QAL PERMIT FEE S /2
Authorized Notice: This permit ap Mention expires If a permit Is not obtained within
Signature: _ Date: 180 docs after it tits bei n ace-pied as complete.
`Feu m,thodologc set b_. Tri-County Building Industry Service Board.
(Please print name)
i•uDsts\Pirmit Forms`•EtcPetmitApp.doc 01!03
Electrical Permit Application - City of Ti(2ard
Page 2 - Supplemental Information
1
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL NN70RK ONLY:
Feefor all systems............................................................ S75.00
(heck Type of Work Involved:
C� Audio and Stereo Systems*
i
nurglar Alarm
Garage Door Opener*
Heating,Ventilation and Air Conditioning System*
Vacuum Systems*
Other
COMMERCIAL WORK ONLY:
Feefor each system.......................................................... $75.00
(SEE OAR 918.260.260)
Check Type of Work Involved:
Audio and Stereo Systems
[� Boiler Controls
Clock Systems
C� Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
4
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
I
Nurse Calls I
Outdoor Landscape Lighting*
Protective signaling,
Other
Number of Systems
* No licenses are required. Licences are required for all
other installations
i\Dsts\Permit Forms\E1cPerm4AppPg2.doc 01103
CITY Or TIGARD 24-Hour
BUILDING
Inspection Line: (503) 639-4'75 MST
INSPECTION DIVISION Business Line: (503) 639-4171 BUP --
rr - _ _ PM -- BLIP
- -
Date Requested— -
--— AM - - —--
�� —Suite__.___-----
M E ------- - -
Location _.
��=-t-f-=----- PLM ---
Ph
Cintact Person
- SWR _ --- - -
Ph
Contractor _ —----- ELC
BUILDING Tenant/Owner -
ELC
Footing
Foundation Access: ELR _ --
Fig Drain
SIT -
Crawl Drain
Slab Inspection Notes:
Post&Beam - ----- - - -
Shear Anchors -
Ext Sheath/Shear -
Int Sheath/Shear - -
Framing
Insulation --
Drywall Nailing '
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof _-- - — - --
Other:--- - _ -
Final - - -- -
PASS ?ART FAIL -- -- —
PLUMBING —
-- --------
Post&Beam
Under Slab - - - -
Rough-In —_ - - - -
Water Service — - —
Sanitary Sewer -- ---- --
Rain Drains
Catch Basin/Manhole
Storm Dr..in __----
Shower Pen ---
Fina{ -------
PASS PART FAIL -----
MECHANICAL - ---- ---- -- __
Post 8 Beam —
Rough-In --- ------- ------
Gas Lire —
Smoke Dampers - -
Final -
PASS PART FAIL —
ELECTRICAL-
ry
Rough-In - - - - -
UG/Slab - — -----
i_ow Voltage ----
Firk, !alarm
Reinspection tee of$—�---- rFlqufred:+afore next inspection. Pay at'airy Hall, 13125 SW Hall Blvd.
s PART FAIL Unable to inspect-no access
- --- Please call for reinspection RE:
-
Fire Supply Line _--
ADA Data Inspeeo --
Approach/Sidewalk
Other:__ DO NOT REMOVE this in&poctlon record front the fob sl
Final
PASS PART FAIL